切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 421 -424. doi: 10.3877/cma.j.issn.1674-3946.2025.04.019.

论著

不同手术在食管裂孔疝合并胃食管反流病患者中的应用观察
赵燕玲1, 王珩1,(), 秦勤2, 李静1   
  1. 1. 610031 成都,成都市第三人民医院普外科胃肠外科病区
    2. 610031 成都,成都市第三人民医院普外科胃肠微创中心
  • 收稿日期:2025-02-12 出版日期:2025-08-26
  • 通信作者: 王珩
  • 基金资助:
    2022年四川省医学会伤口疾病(泰阁)专项科研课题(2022TG06)

Observation on the application of different surgeries in patients with esophageal hiatal hernia complicated with gastroesophageal reflux disease

Yanling Zhao1, Heng Wang1,(), Qin Qin2, Jing Li1   

  1. 1. Section for Gastrointestinal Surgery, Department of General Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu Sichuan Province 610031, China
    2. Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu Sichuan Province 610031, China
  • Received:2025-02-12 Published:2025-08-26
  • Corresponding author: Heng Wang
引用本文:

赵燕玲, 王珩, 秦勤, 李静. 不同手术在食管裂孔疝合并胃食管反流病患者中的应用观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 421-424.

Yanling Zhao, Heng Wang, Qin Qin, Jing Li. Observation on the application of different surgeries in patients with esophageal hiatal hernia complicated with gastroesophageal reflux disease[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 421-424.

目的

探究腹腔镜下Nissen胃底折叠术、Toupet胃底折叠术在食管裂孔疝合并胃食管反流病(GERD)患者中的应用观察。

方法

回顾性分析2022年4月至2023年4月收治的食管裂孔疝合并GERD患者的临床资料,按照手术方法不同,将患者分为Nissen组(行Nissen胃底折叠术)与Toupet组(行Toupet胃底折叠术),依照倾向性匹配法(卡钳值0.02)排除患者基线资料混杂因素,每组各得53例基线资料可比(P>0.05)患者。统计学分析软件SSPS21.0分析整合数据,计数资料用[例(%)]表示,行χ2检验与秩和检验;计量资料用()表示,采用独立样本t检验。P<0.05为差异有统计学意义。

结果

两组患者术中出血量、手术时间、首次排气时间、引流管拔除时间、住院天数均无明显差异(P>0.05);Toupet组患者并发症总发生率显著低于Nissen组(P<0.05);术后6个月,两组患者反流次数、反流时间及胃食管反流评分(GERD-Q)评分显著降低(P<0.05),且Nissen组反流次数与反流时间显著低于Toupet组(P<0.05),而组间GERD-Q差异不显著(P>0.05);术后6个月,两组食管下括约肌压力(LESP)、完全松弛压力(IRP)显著提高(P<0.05),食管远端收缩积分(DCI)显著降低(P<0.05),而组间差异均不显著(P>0.05);术后,Toupet组患者营养状态显著优于Nissen组(P<0.05)。

结论

Nissen与Toupet胃底折叠术均可有效治疗食管裂孔疝合并GERD,Nissen胃底折叠术在改善反流方面更优,Toupet胃底折叠术术后并发症更少,临床可根据实际情况选择手术类型。

Objective

To explore the application of laparoscopic Nissen fundoplication and Toupet fundoplication in patients with esophageal hiatal hernia complicated with gastroesophageal reflux disease (GERD).

Methods

The clinical data of patients with esophageal hiatal hernia complicated with GERD admitted from April 2022 to April 2023 were retrospectively analyzed. According to different surgical methods, the patients were divided into the Nissen group (undergoing Nissen fundoplication) and the Toupet group (undergoing Toupet fundoplication). Confounding factors in the baseline data of the patients were excluded by the propensity score matching method (caliper value 0.02), and 53 patients with comparable baseline data (P>0.05) were obtained in each group. The statistical analysis software SSPS21.0 was used to analyze and integrate the data. Enumeration data were expressed as[ cases (%)], and χ2 test and Rank Sum test were performed; Measurement data were expressed as (), and independent sample t tests were performed. P<0.05 was considered to indicate a statistically significant difference.

Results

There were no significant differences in intraoperative blood loss,operation time, first exhaust time, drainage tube removal time, and length of hospital stay between the two groups of patients (P>0.05); The incidence of complications in the Toupet group was significantly lower than that in the Nissen group (P<0.05); Six months after the operation, the number of reflux episodes, reflux time, and gastroesophageal reflux disease questionnaire (GERD-Q) scores of the patients in both groups were significantly decreased (P<0.05), and the number of reflux episodes and reflux time in the Nissen group were significantly lower than those in the Toupet group (P<0.05), while there was no significant difference in GERD-Q scores between the groups (P>0.05); Six months after the operation, the lower esophageal sphincter pressure (LESP)and integrated relaxation pressure (IRP) of the patients in both groups were significantly increased (P<0.05),and the distal esophageal contractile integral (DCI) was significantly decreased (P<0.05), while there were no significant differences between the groups (P>0.05); After the operation, the nutritional status of the patients in the Toupet group was significantly better than that in the Nissen group (P<0.05).

Conclusion

Both Nissen fundoplication and Toupet fundoplication can effectively treat esophageal hiatal hernia complicated with GERD.Nissen fundoplication is superior in improving reflux, and Toupet fundoplication has fewer postoperative complications. Clinically, the type of surgery can be selected according to the actual situation.

表1 两组食管裂孔疝合并GERD患者一般资料对比
表2 两组食管裂孔疝合并GERD患者围手术期指标(
表3 两组食管裂孔疝合并GERD患者胃食管反流对比(
表4 两组食管裂孔疝合并GERD患者食管测压对比(
[1]
陈立才,刘江斌,盛庆丰,等. 不采用食管探条行腹腔镜手术治疗儿童食管裂孔疝的初步经验[J]. 腹腔镜外科杂志,2023,28(02): 81-84.
[2]
Patel J, Wong N, Mehta K, et al. Gastroesophageal Reflux Disease[J]. Prim Care, 2023, 50(3): 339-350.
[3]
克力木·阿不都热依木. 腹腔镜Nissen胃底折叠术联合胃大弯袖状切除术[J/CD]. 中华普外科手术学杂志(电子版),2014, 8(03): 273-273.
[4]
Aye RW, Baison GN, Ahmed H, et al. The Nissen-Hill Hybrid Repair: Experience With the First 500[J]. Ann Surg, 2022,276(4): 626-634.
[5]
Alimi YR, Esquivel MM, Hawn MT. Laparoscopic Heller Myotomy and Toupet Fundoplication[J]. World J Surg, 2022,46(7): 1535-1541.
[6]
中华医学会. 胃食管反流病基层诊疗指南(实践版·2019)[J].中华全科医师杂志,2019, 8(07): 642-646.
[7]
康珀铭,陶绍霖,谭群友,等. 达芬奇机器人Nissen胃底折叠术治疗难治性胃食管反流病的近期效果[J]. 中国胸心血管外科临床杂志,2020, 27(03): 274-278.
[8]
刘菊,苗嘉萌,李姿,等. 胃食管反流病患者脾胃虚弱评分与GerdQ的相关性研究[J]. 中国中西医结合消化杂志,2019,27(06): 411-414.
[9]
张洪贞,喻军,尹作文,等. 腹腔镜胃底折叠联合胃袖状切除术治疗非糖尿病肥胖症患者的临床研究[J/CD]. 中华普外科手术学杂志(电子版),2022, 16(04): 390-394.
[10]
白浪,张雪玉,白铁成,等. 腹腔镜近端胃切除术中圆锥形重叠吻合成形术对Siewert Ⅱ型AEG患者胃食管反流、营养状态的影响研究[J/CD]. 中华普外科手术学杂志(电子版),2024, 18(06): 679-682.
[11]
翁晓晖,朱晓燕,贺强,等. 腹腔镜抗反流手术治疗胃部分切除术后胃食管反流的疗效观察[J]. 腹腔镜外科杂志,2021,26(03): 182-185.
[12]
Köckerling F, Jacob D, Adolf D, et al. Laparoscopic total (Nissen)versus posterior (Toupet) fundoplication for gastroesophageal reflux disease: a propensity score-matched comparison of the perioperative and 1-year follow-up outcome[J]. Hernia, 2024,28(5): 1629-1639.
[13]
Salman MA, Salman A, Shaaban HE, et al. Nissen Versus Toupet Fundoplication For Gastro-oesophageal Reflux Disease, Short And Long-term Outcomes. A Systematic Review And Metaanalysis[J]. Surg Laparosc Endosc Percutan Tech, 2023, 33(2):171-183.
[14]
Callahan ZM, Amundson J, Su B, et al. Outcomes after anti-reflux procedures: Nissen, Toupet, magnetic sphincter augmentation or anti-reflux mucosectomy?[J]. Surg Endosc, 2023, 37(5): 3944-3951.
[15]
Schröder W, Bruns CJ. Operative Therapie des gastroösophagealen Refluxes-Nissen-oder Toupet-Fundoplikatio? Surgical treatment of gastroesophageal reflux-Nissen or Toupet fundoplication?[J].Chirurgie, 2022, 93(7): 717-718.
[16]
Li G, Jiang N, Chendaer N, et al. Laparoscopic Nissen Versus Toupet Fundoplication for Short- and Long-Term Treatment of Gastroesophageal Reflux Disease: A Meta-Analysis and Systematic Review [J]. Surg Innov, 2023, 30(6): 745-757.
[17]
彭延春,刘祥尧,赵司卫. 腹腔镜食管裂孔疝修补术联合不同抗反流术式治疗食管裂孔疝合并胃食管反流病的临床比较[J]. 中国内镜杂志,2019, 25(04): 11-18.
[18]
Huerta CT, Plymale M, Barrett P, et al. Long-term efficacy of laparoscopic Nissen versus Toupet fundoplication for the management of types Ⅲ and IV hiatal hernias[J]. Surg Endosc,2019, 33(9): 2895-2900.
[1] 唐健雄, 李绍杰. 我国腹腔镜疝外科治疗现状、问题与未来[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 355-358.
[2] 田文, 杨晓冬. 我国腹腔镜疝手术治疗难点与对策[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 359-361.
[3] 李涛, 朱含放, 李世拥. 我国腹腔镜疝修补术式选择与原则[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 362-365.
[4] 宁国龙, 左伟, 侯强强. 两种不同手术方案治疗Meckel憩室肠重复畸形患儿的回顾性研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 380-383.
[5] 辛林璞, 杨敏, 杜峻峰. 五定四观察循证方案对直肠癌造口患者生活质量与应用效果的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 409-412.
[6] 李涛, 朱含放, 李世拥. 腹腔镜下经腹腹膜前右侧腹股沟疝修补术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 366-366.
[7] 李玉庆, 王刚, 李强, 李云川, 杜明新. 不同吻合术对腹腔镜远端胃癌根治术患者的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 286-289.
[8] 曾繁利, 齐秩凯, 杨贺庆. 不同路径腹腔镜胆囊切除术治疗急性胆囊炎的近中期疗效比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 317-320.
[9] 南李刚, 王君妍, 武曦, 伍晓晶, 梁姣, 关蕾, 段降龙. 老年患者开放腹膜前无张力疝修补术与腹腔镜经腹腹膜前疝修补术的临床疗效研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 321-324.
[10] 李健雄, 周江, 李涛, 乔培宇, 汤鑫, 董明. 两种不同保脾胰体尾切除术治疗胰体尾肿瘤的临床比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 325-328.
[11] 卢超, 陈波, 邢志祥, 周鹏, 王帅. 不同入路下腹腔镜解剖性肝脏切除术治疗肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 254-257.
[12] 周丽君, 王露, 林巧. 腹腔镜与开腹直肠癌切除术治疗中低位直肠癌的疗效及并发症对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(02): 146-148.
[13] 陈宝鹤, 张文卓, 王隽. 头尾侧联合入路腹腔镜右半结肠癌根治术的近中期临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(02): 153-156.
[14] 李国防, 陈凯, 管文贤, 刘颂. 消化道术后吻合口漏小鼠动物模型的建立[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(02): 162-165.
[15] 李贞贞, 王宏刚, 崔丽丽, 缪月琴, 刘万璐. 改良管状胃—食管吻合术在腹腔镜近端胃切除消化道重建中的安全性及抗反流效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(02): 176-179.
阅读次数
全文


摘要